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Chronic Pelvic Pain: Diagnosis and Treatment

Trying to describe pain to someone is never easy. It's similar to trying to describe the sound of a flute to someone who was born deaf. This can be particularly difficult when describing pelvic pain because it can be so hard to even know exactly where the pain is coming from.

If you are experiencing chronic or even acute pelvic pain, your first stop should be your physician. Be honest and clear about your pain and be as specific as possible. A good idea is to track your pain in a monthly diary, ranking the level of pain from one to five, with five being so excruciating you can't function and one being the level of mild menstrual cramps. Also note anything you were doing that might be related to the pain. For instance, did the pain occur during or after intercourse? After eating a large meal? During menstruation?

During the conversation with your physician, don't be afraid to tell him or her what you think is causing your pain. Did you have pain like this during a previous ectopic (tubal) pregnancy? When you had an ovarian cyst? This gives your physician a starting point for diagnosis. It is also important to talk honestly and openly about any abuse or sexual trauma you experienced in the past or that may be occurring now. Such trauma can be a cause of pelvic pain.

The first step in diagnosis is a complete medical history and full medical examination, typically including a pelvic examination. Sometimes your physician may initiate treating your pain, even without a clear diagnosis. This might seem disconcerting--how can someone treat your pain if they don't know what's causing it?--but can often work quite well.

Sometimes, however, you may need more tests, including a vaginal ultrasound, in which a small wand is inserted into the vagina. Sound waves from the wand create a picture identifying any masses that may be contributing to your pain. Sometimes a laparoscopy is needed, where a thin tube is inserted through a tiny incision in your abdomen. A small camera on the end of the tube sends a picture back to a screen, allowing the doctor to see any abnormalities in your pelvic region. This is considered surgery, however, and so is used only when the doctor thinks the findings might change the course of treatment. It is not required to begin treatment.

The specific treatment for your pain depends on the diagnosis.

While surgery to remove endometriosis tissue or scar tissue that may be causing the pain can provide short-term relief, the pain tends to return in most women within a year or two.

Your health care practitioner should also talk to you about other options, including counseling to help you better cope with chronic pain, physical therapy or a referral to a pain management clinic. Often, you will need a multifaceted approach to managing your pain that may include medicine, counseling and behavioral changes. And, as with anything complex, you will need to give your health care team time to find the right options for you.

The most important thing, however, is that you don't let anyone minimize your pain. Help and treatment options are available.

References

Levy BS, Apgar BS, Surrey ES, Wysocki S. Endometriosis and chronic pain: A multispecialty roundtable discussion. OBG Mgt (supp). March 2007; S3-S22.

Ozawa Y, Murakami T, Terada Y, Yaegashi N, et al. Management of the pain associated with endometriosis: an update of the painful problems. Tohoku J Exp Med. November 2006;210(3):175-88.

Stratton P. The tangled web of reasons for the delay in diagnosis of endometriosis in women with chronic pelvic pain: will the suffering end? Fertil Steril. November 2006;86(5):1302-4; discussion 1317.

McGowan L, Luker K, Creed F, Chew-Graham CA. How do you explain a pain that can't be seen?: The narratives of women with chronic pelvic pain and their disengagement with the diagnostic cycle. Br J Health Psychol. May 2007;12(Pt 2):261-74.

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© 2008 National Women's Health Resource Center, Inc. (NWHRC) All rights reserved. Reprinted with permission from the NWHRC. 1-877-986-9472 (toll-free). On the Web at: healthywomen.org.

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